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The aim of this study was to design and develop a set of, short message service (SMS) to promote specialized mental health care seeking within the framework of the Allillanchu Project.

Methods

The design phase consisted of 39 interviews with potential recipients of the SMS, about use of cellphones, and perceptions and motivations towards seeking mental health care. After the data collection, the research team developed a set of seven SMS for validation. The content validation phase consisted of 24 interviews. The participants answered questions regarding their understanding of the SMS contents and rated its appeal.

Results

The seven SMS subjected to content validation were tailored to the recipient using their name. The reminder message included the working hours of the psychology service at the patient's health center. The motivational messages addressed perceived barriers and benefits when seeking mental health services. The average appeal score of the seven SMS was 9.0 (SD±0.4) of 10 points. Participants did not make significant suggestions to change the wording of the messages.

Conclusions

Five SMS were chosen to be used. This approach is likely to be applicable to other similar low-resource settings, and the methodology used can be adapted to develop SMS for other chronic conditions.

Sleep difficulties and short sleep duration have been associated with hypertension. Though body mass index (BMI) may be a mediator variable, the mediation effect has not been defined. We aimed to assess the association between sleep duration and sleep difficulties with hypertension, to determine if BMI is a mediator variable, and to quantify the mediation effect. We conducted a mediation analysis and calculated prevalence ratios with 95% confidence intervals. The exposure variables were sleep duration and sleep difficulties, and the outcome was hypertension. Sleep difficulties were statistically significantly associated with a 43% higher prevalence of hypertension in multivariable analyses; results were not statistically significant for sleep duration. In these analyses, and in sex-specific subgroup analyses, we found no strong evidence that BMI mediated the association between sleep indices and risk of hypertension. Our findings suggest that BMI does not appear to mediate the association between sleep patterns and hypertension. These results highlight the need to further study the mechanisms underlying the relationship between sleep patterns and cardiovascular risk factors.

Research suggests that lesbian, gay and bisexual (LGB) adolescents have a higher risk of suicidal behaviours than their heterosexual peers, but little is known about specific risk factors.

Aims

To assess sexual orientation as a risk factor for suicidal behaviours, and to identify other risk factors among LGB adolescents and young adults.

Method

A systematic search was made of six databases up to June 2015, including a grey literature search. Population-based longitudinal studies considering non-clinical populations aged 12–26 years and assessing being LGB as a risk factor for suicidal behaviour compared with being heterosexual, or evaluating risk factors for suicidal behaviour within LGB populations, were included. Random effect models were used in meta-analysis.

Results

Sexual orientation was significantly associated with suicide attempts in adolescents and youths (OR=2.26, 95% CI 1.60–3.20). Gay or bisexual men were more likely to report suicide attempts compared with heterosexual men (OR=2.21, 95% CI 1.21–4.04). Based on two studies, a non-significant positive association was found between depression and suicide attempts in LGB groups.

Conclusions

Sexual orientation is associated with a higher risk of suicide attempt in young people. Further research is needed to assess completed suicide, and specific risk factors affecting the LGB population.

The order Chiroptera is considered the second largest group of mammals in the world, hosting important zoonotic virus and bacteria. Bartonella and hemotropic mycoplasmas are bacteria that parasite different mammals’ species, including humans, causing different clinical manifestations. The present work aimed investigating the occurrence and assessing the phylogenetic positioning of Bartonella spp. and Mycoplasma spp. in neotropical bats sampled from Brazil. Between December 2015 and April 2016, 325 blood and/or tissues samples were collected from 162 bats comprising 19 different species sampled in five states of Brazil. Out of 322 bat samples collected, while 17 (5·28%) were positive to quantitative PCR for Bartonella spp. based on nuoG gene, 45 samples (13·97%) were positive to cPCR assays for hemoplasmas based on 16S rRNA gene. While seven sequences were obtained for Bartonella (nuoG) (n = 3), gltA (n = 2), rpoB (n = 1), ftsZ (n = 1), five 16S rRNA sequences were obtained for hemoplasmas. In the phylogenetic analysis, the Bartonella sequences clustered with Bartonella genotypes detected in bats sampled in Latin America countries. All five hemoplasmas sequences clustered together as a monophyletic group by Maximum Likelihood and Bayesian Inference analyses. The present work showed the first evidence of circulation of Bartonella spp. and hemoplasmas among bats in Brazil.

Air pollution in Mexico City, which has more than 22 million inhabitants, continues to be one of the main environmental issues. Aerosol samples (PM10) collected in Mexico City and the city of Cuernavaca (a clean reference site) have been characterized using different techniques. This multifaceted approach addresses the source apportionment of the carbonaceous matter in PM10, as well as the airborne elements and ions. Accelerator mass spectrometry (AMS) radiocarbon analysis of total carbon, X-ray fluorescence (XRF), and ion chromatography were performed on aerosols collected at three sites in Mexico City and one site in Cuernavaca, during 2 months of the cold-dry season (November–December) in 2012. New results obtained for Mexico City are compared with previous reports. Average levels of PM10 were higher in Mexico City sites (43.3–60.8 μg/m3) than in Cuernavaca (32.2 μg/m3). According to the material balance, PM10 collected in Mexico City had a lower contribution of crustal material (31.2–36.8%) than Cuernavaca (46.9%). Average contributions of particulate carbonaceous matter to PM10 were similar in both cities, but much higher contributions of mineral salts, trace elements, and ions were observed in Mexico City in comparison to Cuernavaca. Total organic carbon (OC) and elemental carbon (EC) contents were higher in aerosols from Mexico City than those from Cuernavaca. The temporal variation results showed that within all locations studied the OC concentration was high compared to the EC. Results from a theoretical calculation of fossil carbon (FC) and biogenic carbon (BC) concentrations showed that FC and BC levels depend on the site: at Mexico City sites, FC was equal or higher than BC. At Cuernavaca, BC was always higher than FC.

This paper explores one aspect of the way in which cult-iconography of the later Iron Age and Roman periods in non-Classical Europe broke the rules of mimetic (life-copying) representation, with, reference to a particular motif: the triple horn. The presence of three-horned images within the iconographic repertoire of western Europe during this period clearly illustrates two aspects of such rule-breaking. On the one hand, the image of the triple-horned bull – well-known in the archaeological record, particularly of Roman Gaul – exemplifies a recurrent Gallo-Roman and Romano-British tradition in which realism was suppressed in favour of emphasis to the power of three. On the other hand, the triple-horned emblem is not confined to the adornment of bulls but may, on occasion, be transferred to ‘inappropriate’ images, both of animals which are naturally hornless and of humans. Such emblematic transference, with its consequence of dissonance and contradiction in the visual message, on the one hand, and the presence of symbolism associated with boundaries and transition, on the other, suggests the manipulation of motifs in order to endow certain images with a particular symbolic energy, born of paradox, the deliberate introduction of disorder or chaos and the expression of liminality. The precise meaning conveyed by such iconographic ‘anarchy’ is impossible to grasp fully but – at the least – appears to convey an expression of ‘otherness’ in which order imposed by empirical observation of earthly ‘reality’ is deemed irrelevant to other states of being and to the supernatural world.

We conducted a survival analysis with competing risks to estimate the mortality rate and predictive factors for immunodeficiency-related death in people living with HIV/AIDS (PLWH) in northeast Brazil. A cohort with 2372 PLWH was enrolled between July 2007 and June 2010 and monitored until 31 December 2012 at two healthcare centres. The event of interest was immunodeficiency-related death, which was defined based on the Coding Causes of Death in HIV Protocol (CoDe). The predictor variables were: sociodemographic characteristics, illicit drugs, tobacco, alcohol, nutritional status, antiretroviral therapy, anaemia and CD4 cell count at baseline; and treatment or chemoprophylaxis for tuberculosis (TB) during follow-up. We used Fine & Gray's model for the survival analyses with competing risks, since we had regarded immunodeficiency-unrelated deaths as a competing event, and we estimated the adjusted sub-distribution hazard ratios (SHRs). In 10 012·6 person-years of observation there were 3·1 deaths/100 person-years (2·3 immunodeficiency-related and 0·8 immunodeficiency-unrelated). TB (SHR 4·01), anaemia (SHR 3·58), CD4 <200 cells/mm3 (SHR 3·33) and being unemployed (SHR 1·56) were risk factors for immunodeficiency-related death. This study discloses a 13% coverage by highly active antiretroviral therapy (HAART) in our state and adds that anaemia at baseline or the incidence of TB may increase the specific risk of dying from HIV-immunodeficiency, regardless of HAART and CD4.

The detection of new binary central stars of planetary nebulae is crucial to definitively determine the importance of binary interactions in the nebular morphology. In this context, we are working on a project that aims to increase the low number of binary central stars detected so far. For that, we are first analyzing public archival data in order to discover potential candidates of binary central stars. These candidates will be subsequently followed-up in order to confirm and characterize them. Here we present our ongoing search and some preliminary results.

The integration of behavioral health services into primary care has led to enhanced use of brief screening measures to identify mental health problems. Although useful, such instruments are largely symptom based and diagnosis specific. This narrow focus can potentially limit the identification of broader social or relational distress in patients that affect medical outcomes, as well as present feasibility challenges using a multi-measure approach in identifying mental health comorbidities.

Method

This exploratory study of adult primary care patients compared an ultra-brief, and widely used measure of global distress across life functioning, the Outcome Rating Scale (ORS), with the Patient Health Questionnaire (PHQ-9 and PHQ-2).

Results

Correlations between the ORS and the PHQ-9 and PHQ-2 indicated agreement between the measures in classifying patients, and the ORS identified significantly more patients in the clinical range.

Discussion

Although results are preliminary, the ORS may cast a wider net in identifying patients with significant distress in primary care.

Multiwavelength and multitechnique observations towards NGC 6309 are presented. The data consist of λ3.6-cm continuum, ground- and space-based imaging, and high and low-dispersion longslit spectra. The structure of the central region seems to be a distorted, ring of 20″ in diameter. The lack of [N II] emission is conspicuous, as revealed by imaging and low dispersion spectra. Notably, the kinematics of the point-symmetric (PS) structures of NGC 6309 indicates the presence of lobes or cavities as those generally found in bipolar nebulae. The results lead to conclude that the origin of this peculiar morphology is not related to BRETs, but rather to that of a bipolar PN with PS structures in its lobes.

Long-slit optical spectroscopy and VLA-B radio continuum (λ = 3.6 cm) observations toward the compact planetary nebulae Cn 3-1 and M 3-27 are presented. Optical spectra were taken at different position angles (PAs) with the 2.2 m telescope at Calar Alto (Spain), covering the range from 6549 to 6751 Å. The radio and optical data show that the ionized shell of Cn 3-1 is an ellipsoid (size ≃ 6″ × 5″, PA ≃ 72°) containing a bright ring-like equatorial zone (size ≃ 2″.6, expansion velocity ≃ 14 km s–1) and two bright point-symmetric arcs, extending from the equator towards the polar regions of the ellipsoid (Fig. 1). These arcs seem to be filamentary structures embedded in the ellipsoid. An ionized stellar wind has been detected through faint extended wings in the Hα (≃ 660 km s–1) and [N II] (≃ 460 km s–1) emission lines. M 3-27 is unresolved at 3.6 cm (size ≤ 0″6). The detected [N II] and [S II] emission lines arise in a compact (≤ 1″4) probably non-spherical region which is identified with the ionized shell of M 3-27. The Hα emission from M 3-27 is dominated by strong emission from an ionized stellar wind and exhibits a Type III P Cygni profile with very extended wings (≃ 3000 km s–1). The estimated kinematic age and ionized mass of Cn 3-1 (≃ 1300 yr, 4 × 10–2 M⊙) and M 3-27 (≤ 530 yr, ≃ 3 × 10–4 M⊙) indicate that both objects are young planetary nebulae. Extended halos (size ≃ 36″ in Cn 3-1, ≃ 24″ in M 3-27) have been spectroscopically detected in both objects. An analysis of the kinematic and emission properties shows that both halos are reflection nebulosities and suggests that the distribution of neutral material in them probably is largely isotropic. The results suggest that the halos correspond to isotropic mass ejections occurred in the last ≃ 2 × 104 yr of the AGB phase of the Cn 3-1 and M 3-27 progenitors.

We present VLA-A radio continuum at 3.6 cm and H92α observations, and optical long-slit spectra at high spectral and spatial resolution of the compact Planetary Nebulae (PNs) Hu 2-1, IC 4997, IC 5117 and NGC 6884. The radio continuum maps show the subarcsecond structure of the PNs in detail. From the optical spectra, the basic kinematical properties can be deduced. The H92α emission line, spatially and spectrally resolved in IC 5117 and Hu 2-1, allows us to observe the kinematics of the PNs in spatial scales of ∼ 0.3″. By combining the radio and optical data, it is possible to identify the components present in the nebulae, to deduce their spatio-kinematical structure, and to obtain estimates for the electron density and temperature, ionized masses and kinematical ages. All this information permits to impose constraints about the mass ejection processes involved in the formation of PNs and when they have occurred.

We report results from observations taken at different wavelengths (optical, radio and NIR) of the bipolar Protoplanetary Nebula OH 231.8+4.2. Radio interferometry with high spatial resolution has been particularly revealing. We study the complex structure and dynamics of this object as well as its rich chemistry.

Observational studies suggest an inverse association between total dairy product intake and diabetes risk. However, there is a lack of information on the relationship of specific dairy products with impaired glucose metabolism (IGM) and type 2 diabetes mellitus (T2DM). Individuals aged 40–75 years were recruited for the Maastricht Study. All the participants filled out a 253-food item FFQ, covering fifty specific dairy items that captured differences between full-fat, semi-skimmed and skimmed products, as well as fermented and non-fermented products. Glucose metabolism status was assessed by an oral glucose tolerance test, and participants were informed on their glucose metabolism status after returning the FFQ. Data of 2391 individuals were available to estimate OR (95 % CI) for IGM (n 470) and newly diagnosed (ND) T2DM (n 125), with adjustment for age, sex, BMI, physical activity, smoking status, education, energy intake and intakes of vegetables, fruits, meat and fish. For IGM, fully adjusted analyses revealed inverse associations, with OR comparing the highest with the lowest tertile of intake of 0·73 (95 % CI 0·55, 0·96) for skimmed products and 0·74 (95 % CI 0·54, 0·99) for fermented products. These dairy products were not associated with ND T2DM. In contrast, full-fat products were positively associated with ND T2DM (OR 2·01; 95 % CI 1·16, 3·47), whereas total dairy product intake was inversely associated with ND T2DM (OR 0·50; 95 % CI 0·26, 0·93). In conclusion, individuals with a high consumption of skimmed and fermented products had lower odds of having IGM, and individuals with a high consumption of total dairy products had lower odds of having ND T2DM. High intake of full-fat products was not related to IGM but was positively related to ND T2DM.

A comprehensive estimation of polyphenol intake is needed to gain a better understanding of the association between polyphenol-rich food intake and the potential effects of this intake on chronic diseases. The aim of this study was to estimate the intake of polyphenols and the major dietary contributors in the population of Sao Paulo. Data were obtained from the Health Survey-São Paulo (ISA-Capital 2008) and were reported for 1103 adults and elderly adults. Food intake was estimated by one 24-h dietary recall (24HR). Polyphenol intake was calculated by matching food consumption data from the 24HR with the polyphenol content in foods listed in the Phenol-Explorer database. The mean total intake of polyphenols was 377·5 (se 15·3) mg/d. The main polyphenol classes were phenolic acids (284·8 (se 15·9) mg/d) and flavonoids (54·6 (se 3·5) mg/d). Intakes were higher in the elderly adults than in other adults (P<0·001) and higher in individuals with lower educational level (P=0·01) and current smokers (P=0·02). The main dietary contributors for total polyphenols were coffee (70·5 %), citrus fruits (4·6 %) and tropical fruits (3·4 %). Coffee was the major source of polyphenols, providing 266·2 (se 16·5) mg/d, and contributed 92·3 % of the phenolic acids and 93·1 % of the alkylmethoxyphenols. These findings will be useful for assessing the potential role on health of polyphenols and specific polyphenol-rich foods, such as coffee, and enable a comparison with people from other countries.

The relationship of the chain ladder method to mathematical statistics has long been debated in actuarial science. During the 1990s it became clear that the originally deterministic chain ladder can be seen as an autoregressive time series or as a multiplicative Poisson model. This paper draws on recent research and concludes that chain ladder can be seen as a structured histogram. This gives a direct link between classical aggregate methods and continuous granular methods. When the histogram is replaced by a smooth counterpart, we have a continuous chain ladder model. Re-inventing classical chain ladder via double chain ladder and its extensions introduces statistically solid approaches of combining paid and incurred data with direct link to granular data approaches. This paper goes through some of the extensions of double chain ladder and introduces new approaches to incorporating and modelling incurred data.

To evaluate the association between length of residence in an urban area and obesity among Peruvian rural-to-urban migrants.

Design

Cross-sectional database analysis of the migrant group from the PERU MIGRANT Study (2007). Exposure was length of urban residence, analysed as both a continuous (10-year units) and a categorical variable. Four skinfold site measurements (biceps, triceps, subscapular and suprailiac) were used to calculate body fat percentage and obesity (body fat percentage >25% males, >33% females). We used Poisson generalized linear models to estimate adjusted prevalence ratios and 95 % confidence intervals. Multicollinearity between age and length of urban residence was assessed using conditional numbers and correlation tests.

Setting

A peri-urban shantytown in the south of Lima, Peru.

Subjects

Rural-to-urban migrants (n 526) living in Lima.

Results

Multivariable analyses showed that for each 10-year unit increase in residence in an urban area, rural-to-urban migrants had, on average, a 12 % (95 % CI 6, 18 %) higher prevalence of obesity. This association was also present when length of urban residence was analysed in categories. Sensitivity analyses, conducted with non-migrant groups, showed no evidence of an association between 10-year age units and obesity in rural (P=0·159) or urban populations (P=0·078). High correlation and a large conditional number between age and length of urban residence were found, suggesting a strong collinearity between both variables.